When using this type of birth control, women start taking active pills at the beginning of the month, and continue to do so for three weeks. These pills have hormones like estrogen and progestin in them that prevent pregnancy. At the end of the month, a woman takes inactive pills, which are usually just sugar pills. These pills maintain the ritual of taking birth control every day to make it easier to remember, and it’s during the week of placebo pills when a woman typically experiences bleeding similar to a period.

In the mispackaged birth control from Qualitest, the pills were flipped upside down 180 degrees so that the inactive and active pills were out of order, according to the company’s press release on the 2011 recall. Taking birth control pills out of order makes them much less effective, as The Mayo Clinic notes.

“As a result of the packaging error,” the lawsuit alleges, “the daily regimen for the birth control pills left women without adequate contraception and at risk for unwanted pregnancy.” The complaint does not specify exactly what happened to the women, except to say that they “suffered damages.”

“The lives of these people have just been turned upside-down because of this,” one of the plaintiff’s lawyers alleged, in a 2012 interview with The Atlantic.

Many of the women who allegedly took the defective birth control have for years been trying to combine their suits, filed in dozens of states, into one class-action suit in one location. In 2014, plaintiffs in Georgia tried to consolidate suits, but that motion was denied. That same year, a California court dismissed a case because the statute of limitations had expired before the couple who had a baby filed their complaint.

Twenty-one states allow plaintiffs to recover limited damages for medical expenses, pain, suffering, lost wages, and resulting problems for their immediate family, while seven allow full recovery for those damages plus costs of raising the child. Oregon even counts the cost of college education as part of the expenses for raising a child, while Arizona, California, Massachusetts, and Minnesota, subtract the potential benefits of having a child.

Endo Pharmaceuticals said in a statement that previous cases that came out of the recall were dismissed because the plaintiffs could not prove that they purchased birth control with the packaging error.

“The voluntary recall occurred based on an extremely small number of pill packs that were manufactured by an external contract manufacturer,” the company said in the statement. “Endo has been able to confirm only one blister pack that manifested a defect and was sold to a patient.” (The recall originally involved a reported 1.4 million packs of birth control, though since there’s rarely time for a full investigation, recalls usually err on the side of recalling any product that may be problematic.)